Infectious Diseases Society of America, Oct. 3-7

The annual meeting of the Infectious Diseases Society of America was held from Oct. 3 to 7 in San Francisco and attracted more than 5,000 participants from around the world, including scientists, physicians, and other health care professionals. The conference featured education courses and comprehensive educational programs focusing on the latest advances in the diagnosis, treatment, and prevention of infectious diseases.

In one study, Kathryn Dalton, V.M.D., M.P.H., of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues found a risk of methicillin-resistant Staphylococcus aureus (MRSA) contamination for pediatric oncology patients who participate in animal-assisted interventions/pet therapy programs in hospital settings, and this risk is higher for patients who have more contact with the therapy dog.

The investigators found that using antiseptic shampoo and wipes on the therapy dog minimized the chances of the dog spreading MRSA to patients, while increasing the safety of pet therapy visits and not diminishing the physical and mental health benefits for patients.

"While there is still a risk of pathogen/germ contamination to patients who participate in pet therapy, using this new antiseptic protocol on the therapy dog can increase the safety of these visits, so it can continue to be used as an important alternative therapy for patients," Dalton said. "We are continuing to do research on this topic, and were just recently awarded a grant to expand this therapy dog intervention to other departments and hospitals. Our goal is to establish evidence-based guidelines for the appropriate implementation of pet therapy in hospitals, to ensure the program's sustainability for patients."

In another study, Rachel L. Epstein, M.D., of the Boston Medical Center, and colleagues found that only one-third of adolescents/young adults with a diagnosed opioid use disorder (OUD) from a national sample of U.S. Federally Qualified Health Centers were tested for hepatitis C virus (HCV), and of those, 11 percent were positive for HCV (i.e., had evidence of exposure to HCV).

"Of youth tested for HCV, only 11 percent were also tested for HIV, despite similar risk factors for each infection and recommendations for at least one-time HIV testing in all individuals 13 to 64 years old (although the age range of that guidance is being re-evaluated)," Epstein said.

For youth diagnosed with HCV, 1.8 percent of those tested had been exposed, a little less than half of those had chronic infection, and about one-third with chronic HCV had evidence of receiving care for their HCV.

"We need to increase HCV testing in youth to meet the U.S. Centers for Disease Control and Prevention's aim to eliminate HCV transmission. HCV testing for only one-third of youth with a diagnosed OUD is not sufficient, and diagnosed OUD likely significantly underestimates the full burden of youth at risk for HCV," Epstein said. "Individual clinicians seeing adolescents and emerging adults can also be more aware of screening for substance use and other risk factors, and they can appropriately test youth for HIV and for HCV, if any of those risk factors are present."

Claudia S. Crowell, M.D., M.P.H., of Seattle Children's Hospital and the University of Washington, and colleagues found that among HIV-exposed uninfected (HEU) children, those who were exposed to efavirenz in utero had a 60 percent higher risk of being diagnosed with a neurological condition after controlling for other risk factors. When considering absolute risks, 9.6 percent of HEU children exposed to efavirenz developed a neurological condition compared with 6.2 percent of children not exposed to efavirenz.

"Of the 3,747 participants, we identified 237 HEU children with confirmed neurological diagnoses; most common [were] microcephaly, febrile seizures, non-febrile seizures, and eye-related disorders," Crowell said. "This was a single study and further study of other cohorts with more exposure to some of the newer antiretroviral agents needs to be conducted to see if our findings can be replicated. Our study highlights the importance of including long-term follow-up of HEU children exposed to antiretrovirals so that we do not miss potential adverse effects of in utero exposure that may not be evident immediately at birth. It is also really important that we continue to follow our cohort to determine the clinical implications of the neurologic conditions found in our study."

In another study, Jeffrey A. Linder, M.D., of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues sought to understand ambulatory antibiotic prescribing. The investigators started with all antibiotic prescriptions, approximately 500,000, and tried to deduce what proportion of prescribing was done at physician visits and if any particular diagnosis could be associated with antibiotic prescribing.

"We found that 20 percent of the antibiotics prescribed were not associated with an in-person physician visit and 46 percent of antibiotic prescriptions were not associated with an infection-related diagnosis," Linder said. "The main concern in implementing an antibiotic stewardship program is that it is incorrect to evaluate antibiotic prescriptions prescribed at patient visits because 20 percent of prescriptions are not associated with an in-person visit. In addition, we really need to understand why 46 percent of prescriptions were associated with a non-infection diagnosis. When we do studies and interventions to improve antibiotic prescribing, we are not seeing the full picture of antibiotic prescribing in the outpatient setting."